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Medicaid Health Plan Pharmacy Benefit

Medicaid Health Plan Pharmacy Benefit

Accessibility & Document Access Notice

This website is committed to providing accessible content in alignment with Section 508 accessibility standards. Some posted documents may not yet be fully accessible. If you are unable to access a document, please contact the MDHHS Common Formulary mailbox at mdhhscommonformulary@michigan.gov or Glenda England at englandg@michigan.gov or 517-331-7473 to request assistance or an accessible alternative.

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MDHHS MEETING ANNOUNCEMENT

Michigan Medicaid Health Plan Common Formulary Stakeholder Meeting

When:       Tuesday, October 27, 2026, from 9:30 a.m. to noon (Eastern Time)

 

Where:      This will be a virtual meeting to encourage statewide participation by stakeholders. To attend the Common Formulary Stakeholder Meeting at 9:30 a.m., connect via Zoom.

 

The Zoom can be accessed by clicking this link and the password is 8Ty1MM. Participants may also access by phone by dialing 408-961-3929 and entering access code 257756.

 

If you need special services to join this meeting, please see information at the end of this announcement.

RSVP:        Attendees are asked to RSVP for this meeting.  If you plan to attend, please notify Donna Kreps at KrepsD@michigan.gov no later than Wednesday, Oct. 21, 2026.

 

The Michigan Department of Health and Human Services (MDHHS) invites the public to attend a stakeholder meeting regarding the Michigan Medicaid Health Plan Common Formulary on Tuesday, Oct. 27, 2026.

The purpose of the stakeholder meeting is to provide a forum for the public to comment on the Common Formulary. This annual forum supplements the quarterly written public comment periods. Please note that drug rebates and Fee-for-Service pharmacy benefit coverage will not be reviewed at this meeting. In addition, the stakeholder meeting is not intended to be a venue for pharmaceutical drug product-specific presentations.

 

Section 1806 of Public Act 84 of 2015 first required the MDHHS to develop a formulary that is common across all contracted health plans to streamline drug coverage policies for Medicaid and Healthy Michigan Plan beneficiaries and providers. The intent was to reduce interruptions in a beneficiary’s drug therapy due to a change in health plan. All health plan member’s drug therapies were then transitioned to the Common Formulary by Sept. 30, 2016. 

 

Effective Oct. 1, 2020, the Medicaid health plans were required to follow the Fee-For-Service Michigan Preferred Drug List (PDL) coverage including any prior authorization and step therapy requirements. This significant savings initiative, the Single PDL, further streamlined and maintains more consistent coverage between Managed and Fee-For-Service Medicaid. Drug products not listed on the Single PDL continue to be covered by the health plans in accordance with the established Common Formulary and may be less restrictive than the coverage parameters of the Common Formulary.

 

Those unable to attend may submit your questions to the Common Formulary mailbox at MDHHSCommonFormulary@michigan.gov by Wednesday, Oct. 21, 2026.

 

Special Services to Join Meeting

 

If you need any of the services below to join, please contact Donna Kreps via email at krepsd@michigan.gov no later than 5 p.m. ET Friday, Oct. 16, 2026, to allow sufficient time set up these arrangements.

 

  •      MDHHS provide free aids and services to people with disabilities to communicate with us, such as:
    • Qualified sign language interpreters.
    • Written information in other formats (large print, audio, accessible electronic formats, other formats).
  •      The department also provides free language services to people whose primary language is not English; such as:
    • Qualified interpreters.
    • Information written in other languages.

 

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Medicaid Health Plan Pharmacy Benefit

This webpage is designed to provide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans.

All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary.

History of Formulary Changes:

General Formulary Information

FOR PROVIDERS AND PRESCRIBERS ONLY
Prior Authorization (PA)

The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below:

Drug PA Criteria

A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. This form or a prior authorization used by a health plan may be used.

  

Medicaid Common Formulary Workgroup Members

Scroll down for health plan specific information. 

 

RESOURCE INFORMATION

BENEFICIARIES

Current beneficiaries can find out which health plan they are enrolled in by calling the Beneficiary Help Line at 800-642-3195 (TTY 866-501-5656) or by logging in to their myHealth Portal account online at www.michigan.gov/myhealthportal.

PROVIDERS

For more information on the drug benefit for people not enrolled in a health plan (Fee-for-Service Medicaid) visit https://mi.primetherapeutics.com.

For more general information on Michigan Medicaid Health Plans, visit www.michigan.gov/managedcare.

This link contains a list of Medicaid Health Plan BIN, PCN and Group Information. Please contact individual health plans to verify their most current BIN, PCN and Group Information.
 

STAKEHOLDER MEETINGS AND COMMENT PERIOD

October 20, 2025, Stakeholder Meeting Presentation

Stakeholder Meeting Questions and Answers

Frequently Asked Questions for Drug Manufacturers 

Drug Class & Workgroup Review Schedule for 2026

 

The next Michigan Medicaid Health Plan Common Formulary public comment period will be announced here.